Background

Hepatocellular carcinoma (HCC) with tumor thrombus extending to the inferior vena cava (IVC) and right atrium (RA) is rare, and is usually associated with serial syndromes and poor prognosis, earlier observations revealed a median survival duration after diagnosis of 1 to 5 months for untreated patients. Surgery, radiotherapy, trans-arterial chemoembolization (TACE), and chemotherapy all had been adopted with poor result.  

Methods

From October 2011 to September 2016, 1850 patients underwent TACE for advanced HCC in our institution. 18 cases were found to have tumor thrombus extended from hepatic vein to IVC and RA. TACE were performed to deal with the tumor thrombus inside the right atrium. Angiography and embolization technique, successful rate, safety and clinical adverse events, and survival time were retrospectively studied.

Results

56 interventional procedures were conducted. All embolization were successfully performed without significant complications. 1 case dead of pneumonia, no severe adverse effects was observed other 17 cases. The 1-, and 3-year overall survival rates for all 18 patients were 50% and 16.7%, respectively, and the overall average survival duration from diagnosis of RATT was 15.2 months.
All RATT had rich blood supply, only 7 cases had single feeding artery, the rest 11 cases had 2 or 3 feeding arteries which originated from intra- or extra-hepatic arteries, extra-hepatic artery played an important role in RATT blood supply, include right inferior phrenic artery (8/18), left inferior phrenic artery (1/18) and the left gastric arteries (2/18).
 

Conclusion

TACE for HCC with tumor thrombus in the IVC and RA could be treated safely and may improve the prognoses of these patients. To ensure the effect, searching for multiple feeding arteries was essential. Carefully observe and suitable embolization technique is essential for safety and effective. Lipiodol is a safe and ideal agent for embolization in RATT.